A few months ago, I crossed the line—from osteopenia to the beginning stages of osteoporosis, the debilitating bone disease. I’m certainly not alone. According to the Centers for Disease Control and Prevention, osteoporosis affects almost one in four women aged 65 and over in the U.S.

Osteoporosis is a common yet serious disease that occurs when the body loses bone mineral density causing the bones to weaken and eventually fracture or break. This results in severe pain and immobility. Approximately one in two women and up to one in four men over 50 will break a bone due to osteoporosis, according to the National Osteoporosis Foundation (NOF). A woman’s risk of fracture is equal to her combined risk of breast, uterine and ovarian cancer, the NOF reports.

Osteoporosis is considered a “silent disease,” because there are no real symptoms and it is believed that many women are walking around not even knowing that they have osteoporosis, until, that is, they fracture a bone. How do we get a handle on this disease and what’s the best approach to managing bone health as we age?

I spoke with Joseph Lane, MD, Chief of Metabolic Bone Disease Service at Hospital for Special Surgery, for advice. The first question I posed concerned bone density screenings which according to industry guidelines should start at age 65. “That’s if you are a perfectly healthy 65-year-old woman,” said Dr. Lane. Those with risk factors would benefit from earlier testing. These factors include family history, low body weight—women who wear a size 2 or have a BMI (body mass index) under 18.5—eating disorders, menopause, long term steroid use or diseases that can cause osteoporosis, such as rheumatoid arthritis, reduced activity levels, illnesses or fractures. “Talk to your internist if you think you may be at risk and get a baseline screening,” advised Dr. Lane.

Calcium of course is important for healthy bones, but what’s the best way to get it? “Number one is to improve your diet,” said Dr. Lane. “Eat something green every day, not peas, but leafy greens.” He also recommends building rich dairy products into your diet, such as yogurt and almond milk. “Then find out your calcium levels.” A 9.5 mg/dl (milligrams per deciliter) range is the safest, according to Dr. Lane. “If it’s below 9, you’re not taking enough calcium. If it’s too high, you could be at risk for kidney stones.” Some studies have linked calcium supplements to kidney stones, however calcium citrate, which Dr. Lane, prefers, is less likely to cause kidney stones and more likely to be absorbed.

Vitamin D is essential in the absorption of calcium, so checking D levels is also important. “You don’t need much—20 ng/ml (nanograms/milliliter) is the magic number,” said Dr. Lane. Sunlight can help the body produce Vitamin D, yet most people don’t spend a lot of time outdoors year-round and wearing sunscreen can prevent the production of Vitamin D. “You have to get pink,” said Dr. Lane, noting that women with darker skin cannot reach D levels through the sun. There aren’t many foods with high Vitamin D, so Dr. Lane recommends taking a Vitamin D 3 supplement. In the hospital’s lab study of women aged 40 through 60, balance was improved by those who took Vitamin D, which proved the important role D also plays in muscle strength and function.

Exercise is a critical factor for bone health, particularly weight-bearing exercise. “You won’t change your bone density, but you’ll improve the quality of the bone,” said Dr. Lane. And exercise can also help improve balance which in turn can help prevent falls and fractures. Rather than just walking on a treadmill, Dr. Lane advises engaging in a variety of exercise such as Tai Chi and Barre classes in addition to walking and walking up stairs, which is also helpful. “Play sports and have fun. If it’s not fun, you won’t do it.” Overall, Dr. Lane is a proponent of a healthy lifestyle of eating good food, being active and maintaining a good weight. “Aim for your marriage weight—don’t go below it.”

Sadly there is no way to reverse bone mineral loss, but good practices can help maintain the bone density that you have and delay or prevent the onset of the disease. For me, my bone density screening score was my wake-up call. Don’t wait to take charge of your bone health. For important resources, visit the National Osteoporosis Foundation and American Bone Health which also has a Bone Health Hotline, 888-266-3015.

Bone Density Screening

DEXA (Dual Energy X-Ray Dual Absorptiometry) is a scan to measure bone mineral density. A T-score of -1 to -2.5 indicates weak bones yet not at risk for fracture (osteopenia). A T-score of -2.5 or lower indicates osteoporosis.

Hip Fractures

24 percent of hip fracture patients age 50 and over die in the year following the fracture, and six months after a hip fracture, only 15 percent of patients can walk across a room unaided. –National Osteoporosis Foundation

Calcium Rich Foods

According to American Bone Health, 75% of Americans don’t get enough calcium. Some good choices are broccoli, kale, bok choy, sesame and chia seeds, almonds, sardines, canned salmon with bones, cheese, milk and yogurt. If you do not get enough calcium through foods or supplements, the body will take the calcium it needs from your bones. Caffeine and alcohol can interfere with calcium absorption.

Books:

There haven’t been many recent books about osteoporosis except for Dexascan: Beyond Missed Opportunity by K.J. Kidd, who details her personal experience with the crippling disease which she says general practitioners are not taking seriously enough.